I have written a book on the politics of autism policy. Building on this research, this blog offers insights, analysis, and facts about recent events. If you have advice, tips, or comments, please get in touch with me at jpitney@cmc.edu

“We see kids whose challenges don’t show up on their report card, so they aren’t getting services,” said Jennifer Choi, a parent and founder of the advocacy group 2eNYC and a trustee of the nonprofit Twice Exceptional Children’s Advocacy. “And we see kids who are gifted, but they also have a disability, who lose the ability to participate in any sort of accelerated program because those programs often decline to provide special education services.”

But a handful of school systems across the country are searching for better ways to accommodate bright students with disabilities. Colorado trains teachers across the state in twice exceptionality, for example, while Montgomery County, Maryland, is perhaps the only school district to offer self-contained classes for students in elementary school who need both an accelerated curriculum and more support than they would receive in a mainstream classroom.

Now parent activists in New York City are fighting to get the country’s largest school system to be more responsive to 2e students. Last fall, after Choi’s group presented the New York City Department of Education with a survey of more than 500 parents that described the challenges facing 2e students, the agency began to offer training to staff in gifted-and-talented programs on how to work more effectively with students who have ADHD. In the last few years, three of the city’s most selective public high schools — Brooklyn Technical, Bard College and Townshend Harris — have sent teachers to learn about twice exceptionality from employees of the Quad Preparatory School, a six-year-old private school that focuses on educating these students. And in New York state, lawmakers introducedbills in 2017 that would require teacher training about twice exceptionality and programming for twice exceptional students.

... One of the biggest barriers to educating 2e students, advocates say, is simply proving they exist. Under the federal Individuals with Disabilities Education Act, all students are entitled to the special services and accommodations necessary to enable them to learn. But to qualify for those services under the law, a student’s disability must “adversely affect educational performance.”

The team, which also includes researchers from the University of Maryland and Johns Hopkins University, examined thousands of tweets sent between July 2014 and September 2017. It discovered several accounts, now known to belong to the same Russian trolls who interfered in the U.S. election, as well as marketing and malware bots, tweeted about vaccines and skewed online health communications.

"The vast majority of Americans believe vaccines are safe and effective, but looking at Twitter gives the impression that there is a lot of debate. It turns out that many anti-vaccine tweets come from accounts whose provenance is unclear. These might be bots, human users or 'cyborgs' -- hacked accounts that are sometimes taken over by bots. Although it's impossible to know exactly how many tweets were generated by bots and trolls, our findings suggest that a significant portion of the online discourse about vaccines may be generated by malicious actors with a range of hidden agendas," David Broniatowski, an assistant professor in GW's School of Engineering and Applied Science, said.

An NBC News analysis of over a million tweets sent by identified Russian trolls published by the data journalism website FiveThirtyEight and Clemson University researchers found over 500 examples of tweets that mention vaccines, often spreading misinformation and discredited theories.

“The Vaccine Hoax is Over — Secret Documents Reveal Shocking Truth,” wrote Russian troll _NICKLUNA_ in February 2017. “Autism Rates in California Have Skyrocketed Following Mandatory Vaccination Bill,” tweeted Amelie Baldwin, a prolific Russian troll, in December of 2016.

The cellphones known as 5G, or fifth generation, represent the vanguard of a wireless era rich in interconnected cars, factories and cities. Whichever nation dominates the new technology will gain a competitive edge for much of this century, according to many analysts. But a television network a few blocks from the White House has been stirring concerns about a hidden flaw.

No government agency has exclusive jurisdiction over all of these areas. The federal government takes the lead with some, while states and localities may be the main arenas for others. At each level, different bureaucracies deal with different aspects of autism. Courts and private organizations also play important roles in autism policymaking. Each place on the autism policy map has its own jargon and rules, hence the “alphabet soup” that bedevils parents.

The IDEA Full Funding Act (H.R. 1878/S. 866) would bring the federal share of funding for special education programs up to 40 percent, the amount the Congress authorized when the IDEA became law in 1975. On March 26, Chris Van Hollen (D-MD) and Pat Roberts (R-KS) introduced the bill in the Senate. House sponsors include Jared Huffman (D-CA) and John Katko (R-NY).

The ABLE Age Adjustment Act (H.R. 1814/S. 651) would increase from 26 to 46 the age threshold for tax-favored ABLE (Achieving a Better Life Experience) accounts. (ABLE accounts are designed to enable individuals with disabilities to save for and pay for disability-related expenses. To establish an account, an individual must have a qualifying impairment that began before the individual attained the age threshold.) House sponsors include Tony Cardenas (D-CA) and Cathy McMorris Rodgers (R-WA). Senate sponsors include Bob Casey (D-PA) and Jerry Moran (R-KS).

The Lifespan Respite Care Reauthorization Act of 2019 (H.R. 2035/S. 995) would reauthorize the Lifespan Respite Care Program (LRCP) program through FY 2024 at $200 million over five years. The bill was introduced in the House by Jim Langevin (D-RI), Cathy McMorris Rodgers (R-WA) and Brian Fitzpatrick (R-PA), and in the Senate by Sen. Susan Collins (R-ME) and Sen. Tammy Baldwin (D-WI).

Transformation to Competitive Employment Act (H.R. 873/S. 260) would phase out subminimum wage certificates over the next six years, support people with disabilities as they enter the workforce, and provide grant funding to employers as they navigate the new labor market. House sponsors are Bobby Scott (D-VA) and Cathy McMorris Rodgers (R-WA). Senate sponsor is Bob Casey (D-PA).

Wednesday, May 29, 2019

Amazon has removed from its offerings several books that promote the use of bleach to cure autism and other health conditions after reports of parents force-feeding their children the toxic chemical as a “miracle cure.”

The books and online publications preach the use of chlorine dioxide, a disinfectant that’s marketed as “Miracle Mineral Solution,” or MMS. A spokesperson for Amazon confirmed the publications’ removal to HuffPost on Wednesday but declined further comment.

Tuesday, May 28, 2019

The GOP tilt is more pronounced among state lawmakers than among federal ones; many prominent Republicans in Congress including most of the 16 GOP doctors have endorsed vaccines. The most visible and voluble exception is Sen. Rand Paul (R-Ky.), an ophthalmologist who says his own kids were vaccinated but the decision should be left to the parents, not the government.

But in states where legislators have advanced serious effortsto tighten restrictions, such as Maine, Washington, Colorado and Oregon, nearly all of the opponents are Republicans who’ve taken a medical freedom stance.

At the extremes are legislators like Jonathan Stickland, a pro-National Rifle Association, Christian conservative in the Texas Assembly, who has described vaccines as “sorcery” while personally attacking Baylor University scientist Peter Hotez, who has a daughter with autism and works on vaccines for neglected tropical diseases. “Parental rights mean more to us than your self-enriching 'science,'" Stickland tweeted at Hotez earlier this month.

That same day, the Oregon Republican Party’s official Twitter account posted that Oregon Democrats were “ramming forced injections down every Oregon parent's throat.”
Other Republican state officials have blamed Central American immigrants for disease outbreaks, echoing a talking point of Fox commentator Lou Dobbs. In fact, experts say, children in many of those countries are more thoroughly vaccinated than their U.S. counterparts against diseases like whooping cough and measles.

From January 1 to May 24, 2019, 940 individual cases of measles have been confirmed in 26 states. This is an increase of 60 cases from the previous week. This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.

U.S. Senators Gary Peters (D-MI), Pat Roberts (R-KS) and Tammy Duckworth (D-IL) announced they introduced the bipartisan VACCINES Act to increase vaccination rates by raising vaccine awareness through a national campaign to combat misinformation.

“We’ve seen firsthand in Michigan the devastating impact of diseases that could have been prevented by vaccines. No one should have to experience the pain of seeing a loved one fall ill or even lose their life because of a vaccine-preventable disease,” said Senator Peters. “This bipartisan legislation would raise awareness about the importance of vaccinations to help more families protect their health and lower health care costs by preventing diseases that require expensive treatments.”

“There are currently hundreds of people throughout the country suffering from measles, a disease that is 100% preventable thanks to modern medicine,” said Senator Roberts. “However, misinformation regarding vaccines has led many to opt out of vaccinating their children, which is causing these illnesses to come back at alarming rates. This legislation will help push back at that misinformation and provide scientific evidence on why everyone should be vaccinated.”

“The recent measles outbreak is extremely troubling, especially as the mother of two young daughters,” Senator Duckworth said. “Vaccinations and immunizations have saved countless lives and are critical in keeping both children and adults safe from preventable deadly diseases. I’m proud to join Senators Peters and Roberts in introducing this bipartisan bill to ensure more Americans understand that vaccines are safe, effective and vital to our nation’s public health.”

The VACCINES Act would direct the CDC to award competitive grants to public or private entities to carry out a national, evidence-based campaign to combat misinformation about vaccines and disseminate scientific vaccine-related information. It would also establish grants to address vaccine-preventable diseases and would support research related to awareness strategies. The VACCINES Act is also included as part of a larger bipartisan legislative package to cut health care costs, released today by the Health, Education, Labor, and Pensions Committee Chair Senator Lamar Alexander (R-TN) and Ranking Member Senator Patty Murray (D-WA).

It would also establish grants to address vaccine-preventable diseases and would support research related to awareness strategies. The VACCINES Actis also included as part of a larger bipartisan legislative package that was introduced today to cut health care costs.

According to the Michigan Department of Health and Human Services, there have been 44 measles cases statewide in Michigan between March 13, 2019 and May 17, 2019. There have been 880 cases nationwide from January 1 to May 17, 2019, according to the CDC. The majority of infected individuals were unvaccinated. Measles, a highly contagious disease, was declared eliminated in 2000, and this marks the highest number of cases in 25 years.individuals were unvaccinated.

As our country is experiencing the greatest number of measles infections in 25 years – 880 cases this year to date – Senate Bill 276, authored by Dr. Richard Pan, a pediatrician and state senator representing the Sacramento region and Assemblywoman Lorena Gonzalez, representing the San Diego area, was passed by the California State Senate on a vote of 24 to 10.

To combat the proliferation of fake medical exemptions, Senate Bill 276 will strengthen oversight of the medial exemption process, which some doctors in the state are abusing by selling medical exemptions to parents.

Senate Bill 276 is co-sponsored by the California Medical Association, the American Academy of Pediatrics, California and Vaccinate California....Under SB 276, physicians will submit information to California Department of Public Health (CDPH), including the physician’s name and license number and the reason for the exemption, which CDPH will check to ensure they are consistent with the Center for Disease Control’s contraindications to vaccination. The physician must also certify that they have examined the patient in person.

Additionally, under SB 276, CDPH will create and maintain a database of medical exemptions. CDPH and County Health Officers will have the authority to revoke medical exemptions granted by licensed physicians if they are found to be fraudulent or inconsistent with contraindications to vaccination per CDC guidelines. This authority will give state and county health officers the tools necessary to contain and prevent further outbreaks.

As a result of the implementation of Senate Bill 277, which abolished the personal belief exemption in California, overall vaccination rates increased sharply to more than 95 percent statewide. That is greater than the 94 percent vaccination rate necessary to achieve community immunity to prevent the spread of a measles outbreak.

The increase followed the dramatic increase from 92.9 percent in the 2015-16 school year to 95.6 percent in the 2016-17 school year after implementation of SB 277 in 2016 and a vaccination rate of only 90.7 percent in 2010-11 when Dr. Pan entered the legislature and authored AB 2109. AB 2109 required parents to be counseled before they opted out of legally mandated vaccines.

Despite the success of SB 277 in increasing the overall immunization rate of kindergarten students, California has also experienced a dramatic increase in the number of medical exemptions. Since the passage of SB 277, the rate of medical exemptions has more than tripled (from 0.2% in 2015-16 to 0.7% in 2017-18). Low vaccination rates in certain pockets of the state have put children and communities at risk.

A very small percentage of the population, less than 1 percent, suffers from qualifying medical condition, such as a severe allergic reaction to a vaccine component that would lead to the granting of medical exemption.

CDPH reports the number of confirmed measles cases here, which have reached 45 in just the four months of the year. The vaccine schedule prevents other types of diseases as well, including pertussis, (also known as whooping cough), which is marked by severe coughing attacks that can last for months. Infants too young for vaccination are at greatest risk for life-threatening cases of pertussis, and a baby in Orange County died from the disease last week.

When measles spreads in a community with immunization rates below 94 percent, the protection provided by ‘community immunity’ is lost. This means many people are at risk of becoming infected including people who cannot be immunized, including infants, chemotherapy patients and those with HIV or other conditions.

The Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act (Section 504), and the Americans with Disabilities Act (ADA) each play a significant part in federal efforts to support the education of individuals with disabilities. These statutory frameworks, while overlapping, differ in scope and in their application to students with disabilities. As a result, when students with disabilities transition between levels of schooling, the accommodations and services they must be provided under federal law may change. For example, while the IDEA, the ADA, and Section 504 potentially apply to children with disabilities from preschool through 12th grade (P-12), only the ADA and Section 504 apply to students in an institution of higher education. More generally, application of the IDEA, Section 504, and the ADA to students with disabilities is determined by (1) the definition of “disability” employed by each framework; (2) the mechanisms employed under each law to determine whether a student has a qualifying disability; and (3) the adaptations, accommodations, and services that must be provided to students with disabilities under each law.

...

The IDEA incorporates a categorical definition of “disability,” identifying a covered “child with a disability” as any “child” having at least one of 13 conditions specifically categorized in the act. Thus, to qualify for services under the IDEA a student of qualifying age must satisfy two requirements. First, the student must have a documented disability that falls in one of the categories enumerated in the IDEA, as further specified by ED’s implementing regulation. And second, as a result of that disability the student must require “special education and related services” in order to benefit from public education. Only if the student meets both criteria will he or she be eligible to receive the principal benefit of the act: specially designed instruction or special education in which the content or the delivery of the instruction is adapted to the child’s individual needs, detailed in a plan known as an individualized education program (IEP).

...

Sections 504 and the ADA draw on a common definition of “disability,” one that is substantially broader than the categorical definition found in the IDEA. Under both laws, an “individual with a disability” includes “any person who (i) has a physical or mental impairment which substantially limits one or more major life activities, (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment.” This definition, unlike the IDEA’s, is not restricted to the educational context. And also unlike the definition used in IDEA, the definition found in Section 504 and the ADA is broadly functional, protecting individuals with any “impairment” affecting a bodily or intellectual function—like seeing, hearing, walking, or thinking.

SCOPE: This report examines occurrences of institutionalization of people with disabilities, as well as threats of institutionalization that were thwarted, in 2017 and 2018, including during Hurricanes Harvey, Irma, Maria, Florence, and Michael, and the California wildfires. This report:

Examines how, when, and why people with disabilities were institutionalized during and after recent disasters.

Examines the systemic issues that continue to cause institutionalization of persons with disabilities.

Provides recommendations and promising practices that would enable federal agencies to eliminate institutionalization of persons with disabilities during future disasters.

SUMMARY: NCD examined available data from several major storms and disasters and found that people with disabilities are frequently institutionalized during and after disasters due to conflicting federal guidance; a lack of equal access to emergency and disaster-related programs and services; and a lack of compliance with federal law.

The report, which focuses on the reasons people with disabilities experience involuntary institutionalization as a result of disasters, found that the Federal Government offers conflicting guidance on the topic.

The report also found that recipients of federal funds do not have training for how to comply with federal requirements to provide equal access to emergency and disaster-related programs and services when using federal dollars, nor do they have the cultural competence to interact with people with disabilties and often adhere to stereotypes and myths about disability that results in institutional placement. As a result of unnecessary institutionalizations during and after disasters, people with disabilities often go unaccounted for, families are separated from loved ones, working individuals with disabilities often become unemployed, and students with disabilities are often excluded from returning to school with their peers. The report concludes with recommendations for federal policymakers.

From the report:

Anecdotal evidence shows that people with mobility disabilities, autism, intellectual disabilities, actual or perceived psychiatric disabilities, dementia, brain injury, and COPD and respiratory disabilities have been unnecessarily institutionalized during disasters in a variety of facilities.

...

One senior executive at a major oil company in Texas who is the parent of a child with autism attributed her inability to resume work after Hurricane Harvey to the lack of child care and transportation from their temporary housing location to her child’s school, which was now several hours away. The relocation of the family’s in-home support providers resulted in the loss of that essential service. The school district offeredresidential care so the mother could resume employment, an illustration of multilayeredeconomic ramifications.

Thursday, May 23, 2019

Although the FDA has issued numerous warnings about the effects of MMS (and although Humble himself has publicly admitted that the substance “cures nothing”), there are still numerous videos on YouTube of Humble promoting the substance as a cure for, among other things, autism, according to a Business Insider investigation; the report also found that the videos were easily accessible on the platform, coming up as a top result in searches for terms like “autism” and, in some cases, racking up millions of views.

There are also a number of private Facebook groups advocating for using MMS or other forms of sodium chlorite as a cure for autism. Such groups, which overlap a great deal with anti-vaccine content, contain shocking testimonials from mothers who administer these treatments to their autistic children, reporting horrifying adverse reactions; in one particularly appalling case, a mother of a six-year-old autistic boy was reportedly investigated by police after giving him a bleach enema, which led to him having his bowel removed and needing a colostomy bag.

Pursuant to the plain language of the December 19, 2016 Equity in IDEA regulation on significant disproportionality, and in conjunction with the March 7, 2019 decision in COPAA v. Devos, the Department expects States to calculate significant disproportionality for the 2018–2019 school year using the 2016 rule’s standard methodology, or to recalculate using the 2016 rule’s standard methodology if a different methodology has already been used for this school year.

The implementation whipsaw is expected to cause problems for states that had relied on the delay of the policy, which relates to disproportional representation of minorities in special education. And these new rules could affect how millions of dollars in federal special education funds are spent at the district level.

The National Association of State Directors of Special Education said that it was "deeply disappointed" in the Education Department's "abrupt" actions, which were announced in a short notice dated May 20 on the department's website. The announcement offers no timetable or additional resources for states.

"A new requirement of this magnitude deserves communication directly from the Department of Education with those responsible for implementation. Moreover, conflicting and untimely direction from the Department is not helpful, nor does it create an effective or efficient means to serve the nation's students with disabilities," said John Eisenberg, the executive director of the special education administrators group, in a statement.

Tuesday, May 21, 2019

When they aren’t working or taking care of their autistic children, Melissa Eaton and Amanda Seigler are moles.

Eaton, 39, a single mother from Salisbury, North Carolina, and Seigler, 38, a mom to six in Lake Worth, Florida, have spent much of their free time in the last three years infiltrating more than a dozen private Facebook groups for parents of autistic kids. In some of these groups, members describe using dubious, dangerous methods to try to “heal” their children’s autism — a condition with no medically known cause or cure.

The parents in many of these groups, which have ranged from tens to tens of thousands of members, believe that autism is caused by a hodgepodge of phenomena, including viruses, bacteria, fungal infections, parasites, heavy metal poisoning from vaccines, general inflammation, allergies, gluten and even the moon.

The so-called treatments are equally confused. Some parents credit turpentine or their children’s own urine as the secret miracle drug for reversing autism. One of the most sought-after chemicals is chlorine dioxide — a compound that the Food and Drug Administration warns amounts to industrial bleach, and doctors say can cause permanent harm. Parents still give it to their children orally, through enemas, and in baths. Proponents of chlorine dioxide profit off these parents’ fears and hopes by selling books about the supposed “cure,” marketing the chemicals and posting how-to videos.

...
Horrified by the treatment of these children, Eaton and Seigler research the parents online to determine their identity and location, then send screenshots of the Facebook posts to the local Child Protective Services division, though they rarely hear back on whether action was taken. The pair say they’ve reported over 100 parents since 2016. They also report the posts to Facebook and have submitted their findings to the Food and Drug Administration, the Department of Justice and child abuse organizations.

Monday, May 20, 2019

From CDC: "From January 1 to May 17, 2019, 880 individual cases of measles have been confirmed in 24 states. This is an increase of 41 cases from the previous week. This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000."

Sustained applause greeted Del Bigtree, a former television producer-turned-activist who often wears a yellow star of David, similar to those required of Jews in Nazi Germany, to show solidarity with parents ordered to keep unvaccinated children at home.

“They have turned our children into the largest human experiment in history — all of history,” he said.

The turnout last week in this suburb hard hit by measles helps explain why New York has become Ground Zero in one of this country’s largest and longest-lasting measles outbreak in nearly 30 years. Even in a religious community grappling with more than 700 cases in Rockland County and New York City since last fall — among them, children on oxygen in intensive care units — anxious and confused parents said they came because they are afraid of vaccines and seeking guidance about what to do.

.,. Ethan, a 36-year-old father of six from Queens who declined to give his last name, said he attended the event out of “a genuine concern” for his family, driven by his wife’s research into vaccines. She had read “a lot of literature” and watched Bigtree’s film, which accuses the government of covering up a purported link between the measles vaccine and autism — a tie repeatedly disproved by studies around the world involving hundreds of thousands of children.

Despite the worst measles outbreak in decades, few state legislatures this year have reconsidered the exemptions that families use to avoid inoculating their children.
As many legislative sessions wind down, only Washington state, which has had one of the highest numbers of measles cases, has sent a measure to the governor’s desk.
...
Every state allows schoolchildren to skip inoculations for medical reasons, such as a compromised immune system or an allergy to a vaccine’s components. And all but three states — California, Mississippi and West Virginia — also give passes to families who claim personal or religious objections to vaccinations.

In many states, that number has been growing. For example, the Houston Chronicle reported this week that nonmedical exemptions granted in Texas rose 14% in 2018-2019, continuing a 15-year upward trajectory.

To be sure, the current outbreak began after most state legislative sessions were underway. But proposals to scale back exemptions that did emerge faced vehement opposition from “anti-vaxxer” groups, which scuttled them in several states.

Dr. Sean O’Leary, a Colorado pediatrician who serves on the infectious diseases committee of the American Academy of Pediatrics, blamed such groups for the failure of a bill in his state.

“The anti-vax groups are loud and pretty organized and have worked for years,” he said.

[P]olitical spending reports filed with the state Elections Division show that the political action committee of one of the groups most active against HB 3063, Oregonians for Medical Freedom, has received nearly $160,000 in political donations since. A good chunk of that money — $87,443 — came from Portland venture capitalist Jonathan Handley and his wife Lisa. They haven't contributed since 2017.

The Handleys' son was diagnosed with autism and Jonathan Handley wrote a book about a connection between autism and vaccines. Over the years there have been many reports and theories on a connection between vaccines and autism, but the scientific community has repeatedly debunked them.

...

Oregonians for Medical Freedom is based in Hillsboro and was registered as a nonprofit last February by the law private firm of Andrew Downs, who also serves as legal counsel for the Senate Republican office.

...
The term "medical freedom" is inherently political. It originated in libertarian circles and is a term used by famed libertarian Ron Paul. Similarly minded groups in several states use the term medical freedom or something similar.

...
Sen. Sarah Gelser, D-Corvallis, said she is worried the success of the opponents could become a playbook for other issues. The opposition pulled people from all walks of life. Some, Gelser said, were pleasant and respectful... Others, she said, made physically and sexually violent threats, wearing the yellow stars of David and making analogies to gas chambers, communism and Jim Crow laws. "I got this heinous email about being raped and being raped harder," Gelser said. "In the past 24 hours, I have been called a turd sandwich, a whore, the C-word, I have been invited to lick, suck and bite various body parts, some of which I've never heard of."

...

One of those who became a regular at the Capitol was Raisa Piatkoff of the Russian Old Believer community in Woodburn. Her community is against the bill for religious reasons.

Public policy toward autistic people is driven by data. Most autism data to date have been derived from and about children, because autism tends to be identified and supported in the public school system. This has created a public perception of autism as a childhood problem. In fact, autism is a lifelong difference or disability, and recent studies suggest serious overlooked concerns for autistic adults. This commentary discusses how we have evaluated adult autism so far, limitations of our knowledge, and how we might evaluate adult needs going forward. The commentary makes a case for specific new adult prevalence and outcome studies to inform public policy.

From the article:

When discussing autism in public policy our first question might be how many adults are actually at risk? The fact is, we do not know the size of our adult autistic population, and we do not know if the outcome data we have is broadly applicable, or only applies to the subset profiled by the studies. The arguments that it does not apply are just as strong as those that it does....Amazingly, there is only one large‐scale study measuring adult prevalence. In 2011, Terry Brugha of the University of Leicester evaluated autism prevalence in a British community [Brugha et al., 2011]. That project was based on a survey of 7461 adults and looked at rates of autism and social attainment. Perhaps the most significant finding was that the rate of autism was not age‐dependent, but the rate of existing diagnosis was. Brugha et al. [2011] found a fairly constant prevalence independent of year of birth. The older the study participant, the less likely they were to have been previously diagnosed with autism.

The finding that most older adults were not originally diagnosed with autism is consistent with anecdotal accounts of older autistic people ...If those and the Brugha et al. [2011] data are a guide, there are many older autistic adults who are unaware they would be on the autism spectrum if evaluated today. Brugha et al. [2011] found very high rates of autism among older adults previously diagnosed with learning disabilities, and they found a large number of autistic people living in group or institutional settings. Neither of those findings are surprising.

According to Brugha et al. [2011], with our current best estimates of prevalence, roughly one in 50 men, or one in 75 people of all ages are on the autism spectrum.

... Adult outcomes range from institutionalization to invisibly blending into the community, yielding a colossal range of implications for supports and services. If we are to have an informed autism policy, we need accurate data characterizing autistic adults. What studies like Croen et al. [2015] show is that the diagnosed (and therefore identifiable) older adult autistic population has an alarming set of problems, but Brugha and other findings suggest they are only a small percentage of the actual adult population. We do not know anything of the health of the rest. To accurately survey the medical issues of all autistic adults, we must identify a broad enough swath to describe the population. That probably means conducting a larger scale study like Brugha et al. [2011] in the U.S.

Gov. Greg Abbott and legislative leaders in Austin surely know that Texas has seen a 2,000 percent increase in vaccine exemptions since 2003, the year we began allowing parents to decline required immunizations for non-medical reasons. Texas saw a 14 percent increase last year alone.